For the second time in two decades, the Veterans Health Administration (VHA) is undergoing a major transformation. The VA Strategic Plan directs VHA to become more Veteran-centric, to use technology to better support health care delivery, and to improve appropriateness, safety, and efficiency of care for the 8.1 million Veterans it serves. Achieving these goals is clearly necessary for the VHA to retain its status as a premier healthcare system in the era of rising healthcare costs and rapid technology advancement. As health care reform broadens choices for citizens, VHA must become a healthcare system where well-informed Veterans choose to obtain their care. The Ann Arbor Center for Clinical Management Research (CCMR) has the expertise, experience, infrastructure, collaborations, and partnerships necessary to help VHA meet these goals. Our vision is to improve the quality, effectiveness, safety, and efficiency of Veteran's healthcare through research and partnerships that are driven by important challenges in clinical management. CCMR, an HSR&D Center of Excellence since 1996, has built the infrastructure necessary to recruit, mentor and support exceptional investigators, promote highly impactful research, ensure safe research practices, and develop enduring collaborations and partnerships. We have brought together 39 superb, multidisciplinary core investigators, many of whom are nationally recognized experts in a broad spectrum of disciplines, including performance measurement, decision-making psychology, behavioral change, systems design, measurement theory, health technology, and implementation science. Our research seeks to result in sustainable clinical and policy impacts in VHA. Thus, whenever possible, we work closely with our clinical, policy, and operations partners as we first develop research ideas and plans, and continue to work with them throughout the project to help ensure a clear path to implementation and impact. Our partners include leaders in our VISN and in VHA Central Office, several of whom have funded CCMR investigators to perform investigations and evaluations that advance their operational priorities. We plan to improve clinical management in VHA through three focused areas (FA) of research: FA1: To incorporate individual patient clinical data and preferences in predictive modeling, decision support tools, and performance measures that increase appropriateness and Veteran-centeredness of care. In the next five years, this work will develop the methods and tools to help VHA develop and implement a state-of-the-art performance management system that allows patients and providers to make individualized decisions about optimal care for common, important clinical situations. FA2: To develop, implement, and evaluate systems-based approaches to improve safety and outcomes for our most vulnerable, high-risk, and complex patients. In the next five years, our investigations will yield the tools necessary to systematically identify patients at high risk for poor outcomes, identify and monitor high-risk clinical practices, and develop and implement system-based interventions to mitigate risk and improve Veterans' outcomes. FA3: To use innovative approaches to improve the effectiveness and efficiency of patient self-management and treatment engagement. In the next five years, our research will produce resources designed to increase the efficiency of support for self-management and behavior change, increase the accessibility and effectiveness of these supports for Veterans, and decrease the adverse impacts of chronic disease on Veterans and their caregivers. In sum, CCMR has brought together an exceptionally strong group of investigators and staff notable for their expertise, productivity and synergistic mix of disciplines. Together, we will conduct innovative research that seeks solutions to common and costly clinical management challenges facing our nation's Veterans.